Carpal tunnel syndrome (CTS) causes pain, numbness, tingling, weakness, and other problems in the hand because of pressure on the median nerve in the wrist.
The carpal tunnel is a narrow opening on the palm side of the wrist that is formed by the carpal bones on the bottom of the wrist and ligaments across the top of the wrist. (“Carpal” is a variation of the Greek word for “wrist.”) Several tendons and nerves pass through the carpal tunnel, an opening that is surrounded on three sides by the carpal bones and forms an arch in the wrist. The median nerve, a major nerve that controls sensation and movement in the thumb and all the fingers of the hand except for the little finger, is one of the nerves that pass through the carpal tunnel.
If the carpal tunnel is compressed (pinched), the result is numbness, tingling, weakness, or pain in the hand, called carpal tunnel syndrome.
Any condition that causes swelling, or a change in position of the tissue within the carpal tunnel, can squeeze and irritate the median nerve. Irritation of the median nerve in this manner can cause pain, tingling, and numbness in the thumb, index, and the middle fingers – a condition called “carpal tunnel syndrome.” The condition can interfere with the ability to use the wrist and the hand.
Carpel tunnel syndrome was first fully described after World War I. Today, it affects about 5% of the people in the United States, and is one of the most common hand conditions requiring surgery.
What Causes Carpal Tunnel Syndrome?
Carpal tunnel syndrome results from narrowing of the carpal tunnel due to swelling. When the carpal tunnel area swells, it can irritate the median nerve. However, many cases of carpal tunnel syndrome have no specific cause. For most people, the cause of carpal tunnel syndrome is uncertain. However, any of the following may be a contributing factor:
Repetitive motions, especially actions when the hands are lower than the wrist, that might overuse the hands.
Hormonal or metabolic changes (menopause, pregnancy, thyroid imbalance, or obesity).
Changes in blood sugar levels (possible with type 2 diabetes).
Other conditions or injuries of the wrist (strain, sprain, dislocation, break, or swelling and inflammation).
Furthermore, there are rare diseases (amyloidosis, sarcoidosis, multiple myeloma, and leukemia) that can cause a deposit of abnormal substances in and around the carpal tunnel, leading to nerve irritation. Additionally, some medical experts believe genetics may be a factor, which in some cases results in a smaller carpal tunnel opening, making the median nerve more susceptible to compression.
What are the Symptoms of Carpal Tunnel Syndrome?
Typically, the symptoms of carpal tunnel syndrome begin gradually. There may be pain, numbness, a tingling feeling, or a burning sensation in the thumb, first three fingers, or the palm of the hand.
Often, it may feel like the fingers “fall asleep” and become numb at night, because of the relaxed position of the hand while sleeping. (Most people sleep with their wrists bent, which places pressure on the median nerve.) In the morning, upon waking, there may be numbness and tingling in the hands that can run up to the shoulder, and the patient may feel a need to shake out their hands.
Symptoms can also include:
Weakness when gripping things, and a tendency to drop objects.
Pain or numbness in one or both hands.
A prickly “pins and needles” sensation in the fingers.
A swollen feeling in the fingers, although the fingers do not appear swollen.
Pain or numbness that is worse at night, which may interrupt sleep.
These symptoms can occur or become worse when driving or holding an object, such as a phone or newspaper.
The symptoms of carpal tunnel syndrome may tend to come and go at first. But over time, they can become more frequent and severe. There may be a sensation of occasional “shocks” in the thumb and fingers. And, numbness in the affected area may become constant, making it more difficult to make a fist.
As carpal tunnel syndrome becomes more severe, the muscles in the hand may shrink. Pain and muscle cramping will become worse. The median nerve may begin to lose function, leading to:
Slower nerve impulses.
Loss of feeling in the fingers.
A loss of strength and coordination, especially the ability to use the thumb to pinch making it difficult to manipulate small objects, as with buttoning a shirt or placing an earring.
Permanent muscle damage and a loss of hand function.
A loss of muscle at the base of the thumb.
The inability to distinguish hot and cold by touch.
Complications of carpal tunnel syndrome are uncommon, but the symptoms can become permanent if not corrected early.
How is Carpal Tunnel Syndrome Diagnosed?
A proper diagnosis of carpal tunnel syndrome begins with a physical exam and a review of the patient’s medical history. In reviewing the medical history, a doctor will look for a pattern of symptoms, and test for feeling in the fingers. Symptoms that appear in the little finger may indicate a problem other than carpal tunnel syndrome because the median nerve doesn’t provide sensation to that finger.
In a physical exam, the doctor will examine the wrist for swelling, warmth, tenderness, deformity, and discoloration. The doctor may bend the wrist, tap on the nerve, or simply press on the nerve. These actions can trigger carpal tunnel symptoms in many people. The doctor will also test the strength of hand muscles.
Other diagnostic tests include:
X-ray. Sometimes it may be necessary to take an X-ray of the affected wrist to exclude other causes of wrist pain, such as arthritis or a fracture.
Computed Tomography scan (CT or CAT scan). This imaging test combines a series of X-ray images taken from different angles and uses computer processing to create cross-sectional images. CT scans can determine the extent and cause of the condition such as an injury or inflammation.
Magnetic resonance imaging (MRI). Radio waves and a magnetic field create three-dimensional images of the wrist. An MRI performed with a high magnetic field strength usually provides the most conclusive evidence for which nerves are affected.
Electromyogram. A test to measure the electrical discharges of the muscles. The test evaluates the electrical activity when muscles contract and rest. This test can identify muscle damage and can rule out other conditions. Electromyograms are useful in determining whether there is pressure on the median nerve in the carpal tunnel. Sensors can reveal the severity of injury, or how much the nerve is being pinched.
Nerve conduction study. As a variation of an electromyogram, this test checks to see if electrical impulses are slowed in the carpal tunnel.
Blood tests. Sometimes it may be necessary to identify underlying medical conditions associated with carpal tunnel syndrome. Typical blood tests include thyroid hormone levels, complete blood counts, and blood sugar and protein analysis.
How is Carpal Tunnel Syndrome Treated?
Carpal tunnel syndrome tends to begin slowly and worsen over time. Starting treatment early for the condition usually has better results and quicker recovery.
There are many options available for treating carpal tunnel syndrome. The choice of treatment for carpal tunnel syndrome depends on the severity of the symptoms, and any underlying disease that might be causing the symptoms. In cases where the symptoms are mild to moderate, treatment may be as simple as wearing a brace or wrist splint.
Treatment for carpal tunnel syndrome is based on:
The age of the patient.
The patient’s overall health and medical history.
How bad the carpal tunnel syndrome is at the beginning of treatment.
How well the patient can tolerate specific medications, procedures, or therapies.
How far the disease is expected to develop.
Most patients with carpal tunnel syndrome improve with conservative measures and medications. However, constant pressure on the median nerve can result in persistent numbness and weakness. To avoid serious and permanent nerve and muscle damage from the consequences of carpal tunnel syndrome, surgical treatment may be necessary.
Some simple home remedies to help ease the symptoms of carpal tunnel syndrome include:
Ice. Place ice on the wrist or soak the hand and wrist in an ice bath. Try it for 10 to 15 minutes, once or twice an hour.
Heat. Some experts suggest placing the hand in warm water, around 100° F, then gently flex and extend the hand and wrist. Repeat 3-4 times a day.
Shake. Gently shake the wrist for pain relief. Also, hang the wrist over the side of the bed for pain that wakes you while sleeping.
Rest. Resting the hands and wrists as much as possible is also beneficial. Give them a break from things that trigger your symptoms.
Medication. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and other nonprescription pain relievers, may ease symptoms present for a short time, or caused by strenuous activity. Also, oral diuretics can decrease swelling.
While these methods can help, remember that they do not cure carpal tunnel syndrome. At best, they provide short-term relief.
Wrist braces are generally most helpful when the symptoms are mild to moderate. Braces do not work for everyone; however, there are no side effects, so it doesn’t hurt to try one. Wear the brace for at least 3-4 weeks for symptoms to improve. Wear the brace during the day, especially when doing activities that trigger flare-ups.
It may also help to wear the brace while sleeping, since most people bend their wrists when they sleep, causing symptoms to worsen.
Carpal tunnel syndrome often begins after holding the hands and wrists in the same position for a long time. It can be worse if it is necessary to keep the wrists bent (up or down). It is best to maintain the wrist in a straight, neutral position.
If the activity or work makes it difficult to keep the wrist in a neutral position, try the following:
Take a break for 10-15 minutes every hour to stretch your hands and wrists.
See if it is possible to change the work area or tools.
If possible, alternate hands while doing the tasks.
Use only as much force as is necessary. Don’t hold tools too tightly or pound away at a keyboard.
Watch your posture. Try not to roll your shoulders forward, which sets off a chain reaction that makes wrist problems even worse.
Corticosteroids, such as cortisone, are potent drugs that can help lessen swelling. Steroids can be administered as a pill or as a shot directly to the wrist and into the carpal tunnel. A corticosteroid can provide temporary relief from the pain and swelling, but it is not a long-term solution.
Physical and Occupational Therapy
Occupational and physical therapists can help with exercises to stretch and strengthen the hand and wrist muscles. They can also help with alternative ways to perform tasks and ease the stress on your hands and wrists. This can be especially helpful for everyday tasks at work or home. Research finds that both physical therapy and surgery can help, but physical therapy leads to better outcomes in the short term.
Some people with carpal tunnel syndrome have success with alternative or complementary medicine. Some options are:
Yoga. Research shows that yoga can ease pain and boost grip strength.
Ultrasound therapy. Treatment using sound waves to raise the temperature in the hand and wrist. The heat can relieve pain and help with healing.
Acupuncture. Research has found that acupuncture can improve the overall symptoms of carpal tunnel syndrome in some patients.
If other treatments haven’t improved your symptoms in 6 months, carpal tunnel release surgery might be an option. With surgery, the ligaments are cut around the carpal tunnel to take pressure off the medial nerve and relieve symptoms. Patients can expect soreness for anywhere from a few weeks to a few months after surgery.
What Are the Risk Factors for Developing Carpal Tunnel Syndrome?
There are several risk factors associated with carpal tunnel syndrome. Although these factors may not directly cause carpal tunnel syndrome, they can increase the chances of developing or aggravating median nerve damage. These include:
Anatomic factors. A wrist fracture or dislocation, or arthritis that deforms the small bones in the wrist, can alter the space within the carpal tunnel and put pressure on the median nerve. Anyone with smaller carpal tunnels may be more likely to have carpal tunnel syndrome.
Sex. Carpal tunnel syndrome is generally more common in women than men. This may be because the carpal tunnel area is relatively smaller in women.
Nerve-damaging conditions. Some chronic illnesses, such as diabetes, increase the risk of nerve damage, including the median nerve.
Inflammatory conditions. Illnesses that are characterized by inflammation, such as rheumatoid arthritis, can affect the lining around the tendons in the wrist and place pressure on the median nerve.
Obesity. Being obese is a significant risk factor for developing carpal tunnel syndrome.
Alterations in the balance of body fluids. Fluid retention may increase the pressure within your carpal tunnel, irritating the median nerve. Retaining fluids is common during pregnancy and menopause. Carpal tunnel syndrome associated with pregnancy generally resolves on its own after the pregnancy.
Other medical conditions. Certain conditions, such as menopause, thyroid disorders, and kidney failure, may increase the chances of carpal tunnel syndrome.
Workplace factors. It’s possible that working with vibrating tools or on an assembly line that requires prolonged or repetitive flexing of the wrist may cause harmful pressure on the median nerve, or worsen existing nerve damage.
Several studies have evaluated whether there is an association between computer use and carpal tunnel syndrome. However, there has not been enough quality and consistent evidence to support extensive computer use as a risk factor for carpal tunnel syndrome, although it may cause a different form of hand pain.
Novus Spine & Pain Center
Novus Spine & Pain Center is in Lakeland, Florida, and specializes in treating Carpal Tunnel Syndrome pain. By using a comprehensive approach and cutting edge therapies, we work together with patients to restore function and regain an active lifestyle, while minimizing the need for opiates.